Julie Cowie

University of Stirling, School of Health Sciences, Lecturer (407)

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Survey Questionnaire for community rehabilitation service provision in Scotland

University of Stirling. NMAHP Research Unit, Nov 30, 2020

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Soil Analysis Support System for Archaeologists (SASSA)

Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial

BMJ Quality & Safety

BackgroundImproving the quality and efficiency of healthcare is an international priority. A rang... more BackgroundImproving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design.MethodThe objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward...

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Additional file 9 of The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review

Additional file 9. Key examples of barriers and facillitators within Initiative design and delivery.

Additional file 6 of The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review

Additional file 6. Methodological quality assessment for mixed method design studies.

The Scottish Ambulance Service New Clinical Response Model Evaluation Report

Category level results-comparison of count data ('more accurately identified') 3.2.4 Condition le... more

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Soil Analysis Support System for Archaeologists (SASSA)

Frameworks to maximise effective intervention sustainability in a hospital setting - a systematic review

Background Aarhus Municipality works continuously with quality improvement in the elderly care e.... more Background Aarhus Municipality works continuously with quality improvement in the elderly care e.g by developing a management tool to improve patient safety culture (PSC). PSC is considered fundamental for the delivery of safe care and can be described as an aggregation of individuals' behavior, habits, norms, values and basic assumptions related to patient care. Literature shows that leadership frames the quality of the culture under which the staff practices safety. However, culture is a complex phenomenon. As a manager, a tool to identify PSC can be useful to get insight into the culture. Despite that primary care is the most rapidly growing segment of the healthcare sector, studies of PSC are mostly conducted in hospital settings resulting in a significant knowledge gap in primary care. However, this study shows how a Safety Attitude Questionnaire (SAQ), developed for hospital settings, can be tested and adjusted to primary care and used for identifying quality improvement activities. Methods The primary target group was managers and frontline staff in elder care. The intervention was a twostep process of 1) quantitative SAQ-DK questionnaire and 2) a qualitative follow-up concept. SAQ-DK questionnaire: 10 validated questions from the Danish translation of SAQ were selected (SAQ-DK). For each question explanatory texts were written, and pilot tested to ensure full understanding in an elder care setting. The questionnaire was distributed by e-mail to frontline staff and their managers in 7 nursing home units and 2 home care teams. Follow-up concept: is a three-step structured process with high level of staff involvement. This gives managers and staff a platform enabling dialogue about their culture and enabling how to prioritize improvement activities. The result is a driver diagram. Outcome Average response rate of the SAQ-DK was 87.11% Follow-up concept showed that 7 out of 9 units participated in a facilitated workshop and the improvement activities were structured in local driver diagrams. One manager from a nursing home expressed that "…the actual measurement gives me an insight into where we can benefit from development and improvement". Qualitative assessment showed that the managers have taken lead and chosen dedicated staff members to implement the improvement activities according to the model of improvement. The units follow their improvement activities with local result and process indicators. A manager expresses that: "improvement activities and culture may be a fluffy size but with the SAQ we express what we can work with in the daily improvement work. It has improved both the workflows and the working environment, and at the same time it has meant that the elderly gets a better care". Conclusion Our results showed that using SAQ-DK in elder care can help initiate systematic quality improvement activities and contribute to enhance PSC. However, building a PSC needs a clear leadership focus. Leaders need to enable the staff to take ownership and allow quality improvement activities in their day-today practice.

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FRI0401 IMPLEMENTATION of Nice Guidelines for Osteoarthritis in Primary Care. Feasibility Study of Jigsaw-E in Scotland

Annals of the Rheumatic Diseases, 2020

In the UK osteoarthritis (OA) is a common musculoskeletal problem with 8.75 million people seekin... more In the UK osteoarthritis (OA) is a common musculoskeletal problem with 8.75 million people seeking treatment in 20151.Evidence-based guidelines are available for the management of OA but implementation into routine daily practice remains complex. The Joint Implementation of Guidelines for Osteoarthritis in Western Europe (JIGSAW-E) model of care was developed and evaluated in England and implemented in Europe with an aim to optimise quality primary care for OA, support self-management and promote use of NICE guidelines2. The intervention includes:1. An OA guidebook for patients2. A model OA consultation for primary care3. Training for practitioners to deliver the model consultation4. Measures of quality care using an e-templateTo explore the feasibility of implementing the JIGSAW-E model to support people with OA in Scottish primary care.Research questions were informed by the Theoretical Domains Framework with an aim of:1) Exploring knowledge and beliefs about OA and its management...

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A national survey of community rehabilitation service provision for people with long Covid in Scotland

F1000Research, 2020

Background: Over 50 million cases of COVID-19 have been confirmed globally as of November 2020. E... more Background: Over 50 million cases of COVID-19 have been confirmed globally as of November 2020. Evidence is rapidly emerging on the epidemiology of COVID-19, and its impact on individuals and potential burden on health services and society. Between 10–35% of people with COVID-19 may experience post-acute long Covid. This currently equates to between 8,129 and 28,453 people in Scotland. Some of these people will require rehabilitation to support their recovery. Currently, we do not know how to optimally configure community rehabilitation services for people with long Covid. Methods: This national survey aimed to provide a detailed description of current community rehabilitation provision for people with long Covid in Scotland. We developed, piloted, and conducted a national electronic survey of current community rehabilitation service provision for people presenting with long Covid symptomatology. Our sample were the Allied Health Professions Directors of all 14 territorial NHS Healt...

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Right at home: living with dementia and multi-morbidities

Ageing and Society, 2020

Dementia is recognised as the biggest health crisis of our time in terms of high personal and soc... more Dementia is recognised as the biggest health crisis of our time in terms of high personal and social costs and wider impact on health and social care systems. Increases in people living with dementia and multi-morbidities presents critical challenges for home care worldwide. Health-care systems struggle to provide adequate home-care services, delivering limited care restricted to a single-condition focus. This study explored the experiences and expectations of home care from the multiple perspectives of people living with dementia and multi-morbidities and home-care workers providing support. Findings draw from qualititative semi-structured interviews with people with dementia (N = 2), their partners (N = 2), other partners or family carers (N = 6) and home-care workers (N = 26). Three themes are identified: (a) the preference for and value of home; (b) inadequate home-care provision and enhanced care burden; and (c) limited training and education. Despite continued calls for home-c...

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Predictive modeling of adverse events in chemotherapy

Journal of Clinical Oncology, 2012

e19617 Background: Patients with cancer receiving chemotherapy are at risk of developing severe o... more e19617 Background: Patients with cancer receiving chemotherapy are at risk of developing severe or life threatening adverse events (AEs). The aim of this study was to develop and test a risk model for six common toxicities based on a detailed analysis of daily self-reported symptoms. The retrospective study was performed on a data set of 33 breast cancer patients who self reported symptoms over multiple therapy cycles. The monitored symptoms were diarrhoea, hand-foot syndrome, mucositis, nausea, vomiting and fatigue. Methods: The data analysis focused on four toxicity aspects: the occurrence patterns, the severity distributions, the duration and the interrelationship between symptoms. The clustering of symptoms was a key aspect of the modeling. The data analysis was supported and augmented with knowledge from an expert group of clinicians and an advisory group of patients. The final model is a Bayesian network in which the probability of toxicity on a given day, depends on the proba...

Symptom management pathways for patients undergoing adjuvant chemotherapy for breast and colorectal cancer: the application of process maps

Evaluating ASyMS: process mapping symptom management pathways across the UK

Supportive self-care strategies during chemotherapy treatment: A longitudinal qualitative exploration of the experiences of patients with breast or colorectal cancer

Background: The Advanced Symptom Management System (ASyMS) is a mobile phone based system to remo... more Background: The Advanced Symptom Management System (ASyMS) is a mobile phone based system to remotely monitor and manage the toxicities of cancer treatment in the home care setting. ASyMS is being evaluated in a three-phase, multi-site complex intervention study, with a before and after study design. The study is exploring the impact of ASyMS on care delivered to people with breast/colorectal cancer receiving adjuvant chemotherapy. The shift of chemotherapy administration into the ambulatory setting requires patients to engage in self-care activities to prevent or reduce the severity of numerous and possible complex side effects. Phase I of the study is now complete. This paper will present the experiences of patients interviewed longitudinally throughout Phase I in relation to the supportive self-care behaviours and strategies they engaged in during their chemotherapy treatment. Material and Methods: A total of 141 patients were recruited to Phase I. Of these 141 patients, 23 indiv...

Real-time management of chemotherapy toxicity using the Advanced Symptom Management System (ASyMS)

Journal of Decision Systems, 2013

This paper describes an ongoing study of the Advanced Symptom Management System (ASyMS) for patie... more This paper describes an ongoing study of the Advanced Symptom Management System (ASyMS) for patients receiving chemotherapy for breast or colorectal cancer. We begin by detailing the ASyMS work to date, providing an overview of research conducted in the field over the last ten years. The current study, ASyMS-III, is then presented, highlighting the study methodology, multi-site involvement, the outcomes being measured, and discussion of the tool. The paper concludes with reflections on the progress of the ASyMS-III study to date, and discusses potential directions for future research.

Soil Analysis Support System for Archaeology (SASSA)

Evaluation of Impact of ASyMS

Intelligent user support for MCDA A case study

Includes bibliographical referencesSIGLEAvailable from British Library Document Supply Centre- DS... more

NCRM report for SAS

Executive Summary The Scottish Ambulance Service (SAS) responds to around 1.8 million calls per y... more Executive Summary The Scottish Ambulance Service (SAS) responds to around 1.8 million calls per year, including responses to 700,000 emergency and unscheduled incidents. Of these responses, over 500,000 are received through the 999 call service. SAS transfers around 90,000 patients between hospitals each year and responds to over 150,000 urgent requests for admission, transfer and discharge from GPs and hospitals (SAS, 2015). In 2017 SAS began to implement a new clinical response model (NCRM). The aims of the NCRM are to: - Save more lives by more accurately identifying patients with immediately life-threatening conditions, such as cardiac arrest; - Safely and more effectively send a matched resource first time to all patients based on their clinical need. The University of Stirling, commissioned to carry out an independent evaluation of the NCRM using data provided by SAS and NHS Information Services Division (ISD), considered the following questions: 1. Are patients with Immediate...

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